{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CALLIE   M MCLAUGHLIN","gend":1,"add":"448 KEARNS DR","city":"CULPEPER","state":"VA","zip":"22701-9998","dob":"1963-08-23","age":"","mstatus":"","insh":"1953256*01","cliId":"","pno":"703\/200-8296","cno":"703\/200-8296","email":"","ename":"","eno":"","pphy":"KIM, JUN MD","ppno":"540\/825-6100","pcpadd":"1200 SUNSET LANE STE 2210","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":22701,"pcpcounty":"","pcpid":100582,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/825-1829","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z87.891","M54.16","Z79.891","J41.0","J45.20","J40.","E66.9","R74.8","Z12.31","D24.2","D24.1","Z03.818","M47.26","M51.9","M54.5","N63.10","N63.20","M47.896","Z12.2"],"date":["2021-07-14","2020-12-11","2021-01-29","2021-08-07","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-06-15","2020-06-15","2020-06-15","2020-11-30","2021-01-29","2021-01-29","2021-01-29","2020-06-15","2020-06-15","2020-12-11","2021-07-14"],"priorHcc":["","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68382031910","TRAMADOL","50MG","14","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","-10","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","60","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","51672404806","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","60505025103","TIZANIDINE","2MG","90","Select","Select",""],["","00378064205","PREDNISONE","20MG","10","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","30","Select","Select",""],["","51991074790","DULOXETINE","30MG","-60","Select","Select",""],["","00093742698","MONTELUKAST","10MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","-10","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","68382031910","TRAMADOL ","50MG","14","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","60505025103","TIZANIDINE ","2MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","-60","Select","Select",""],["","00378064205","PREDNISONE ","20MG","10","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","30","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","90","Select","Select",""],["","51991074790","DULOXETINE ","30MG","60","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}